Comparison of automatic staplers in small bowel anastomoses

Abstract

Automatic stapling instruments have been used in gastrointestinal operations with increasing frequency. As a result, newer staplers have been developed which use more staples and compress the tissue to a greater degree. Our study was designed to compare one of the newer devices (GIA Premium) with a conventional device (ILA) in regard to tensile strength, bursting pressure, and histology. Functional end-to-end jejunal anastomoses were created in dogs and studied acutely and chronically. Acutely, the pressure needed to produce a staple line leak was greater with the GIA Premium; however, after healing no difference was noted. Total work required to disrupt a staple line was greater with the GIA Premium and remained so after healing. Fibroconnective tissue density was greater after healing in anastomoses created with the GIA Premium stapler. The data suggest a theoretical advantage in using the GIA Premium stapler, though both staplers produce an anastomosis adequate to resist the usual physiologic stress that may be encountered in man.